Basic Information
| Provider Information | |||||||||
| NPI: | 1174976740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICOLE SAPIRO VINCKIER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 WEBSTER ST | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480097090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187263262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2486479864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2016 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | SANBORN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2486479860 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENERATIONS OB-GYN | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601007743 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.